Acid Reflux - Causes
Acid reflux or GERD (gastroesophageal reflux disease) occurs when the liquid that is in the stomach backs up into the esophagus. This is usually a condition which persists throughout the life of the individual. Because the acid backs up into the esophagus, the esophagus may be damaged.
Acid reflux (GERD) can have many causes. The action of the lower esophageal sphincter (LES) may be one cause. The esophagus connects to the stomach. There is a muscle ring that goes around the end of the esophagus at the point where it meets the stomach. This is the LES. When we eat or drink the LES allows the food to pass into the stomach and then the muscle ring closes so the food does not reflux. People with acid reflux (GERD) may have abnormalities with their LES. The LES may have a weak contraction so there is a very good chance of reflux. Or, the LES may be too relaxed. The longer the LES is open (relaxed) reflux can easily occur.
Another cause of acid reflux (GERD) is a hiatal hernia. Some people with acid reflux have hiatal hernias and some do not. Hiatal hernias are not a pre-requisite for acid reflux, but a large amount of people with acid reflux DO have hiatal hernias. A hiatal hernia disrupts the location of the LES. The LES should be on a level with the diaphragm but due to the hiatal hernia the LES is pushed up and lies in the chest. This is a problem because the diaphragm is a large part of helping the LES to prevent reflux. Now the pressure of both the LES and diaphragm are not working as a strong unit. The hiatal hernia contributes to the reflux because of the decreased pressure.
Acid reflux can also be caused by a hiatal hernia due to the hernial sac. The location of the sac is near the esophagus. Acid gets trapped in the sac. Because the sac is so close to the esophagus, when the LES relaxes, it is easy to reflux.
The hiatal hernia can lead to acid reflux in a third way. Normally the esophagus connects to the stomach at an angle creating a flap of tissue. The hiatal hernia leads to the flap becoming warped and therefore it is useless to stop reflux.
People with acid reflux have a problem with the contraction of the esophageal muscles when they swallow. This is an issue because the contraction pushes all of the items in the esophagus into the stomach. If there is not a good contraction then the acid does not get pushed back and remains in the esophagus. Smoking disturbs the clearing of the esophagus too. It takes about six hours from the last cigarette you smoke for the effect on the esophagus to wear off.
Acid reflux is most common after meals. It is always better to be vertical so gravity can help the acid move down into the stomach. Large meals are not recommended for people with acid reflux.
There are many different reasons people may have acid reflux. Learning the cause may help in your quest to relieve some of the discomfort of acid reflux.
Acid Reflux - Is It Just Indigestion?
What is acid reflux though?
It is the liquid in the stomach regurgitating into the oesophagus (gullet). Much of this liquid is acid produced in the stomach which is harmful to the walls of the oesophagus. Reflux happens to most people but because we spend much of our time upright, gravity ensures that the liquid returns to the stomach unnoticed. In addition, we swallow frequently which again returns regurgitated liquid to the stomach and saliva contains bicarbonate which helps to neutralise the acid in the stomach liquid.
It doesn’t do to ignore repeated instances of painful indigestion though, as it could be symptomatic of something much more serious. That refluxing acid can cause lasting damage to the lining of the oesophagus, which, if left untreated, can lead to other conditions.
A friend relates that when she was a child, her father was always chewing on Rennies, a well known antacid in the UK. He used to say that a good belch would cure the indigestion. It later turned out that he had a stomach ulcer. Despite that, when my friend, in turn, started suffering from frequent indigestion, she too chewed on the Rennies and went about her business.
Eventually, she realised that the extent of the indigestion couldn’t be normal so she consulted her doctor who referred her to a specialist for an endoscopy.
An endoscopy is a procedure whereby an endoscope, a thin, lighted tube, is inserted down the throat. The endoscope transmits images of the oesophagus, stomach, and duodenum, enabling the specialist to identify problem areas and, if necessary, obtain biopsies. The endoscope is usually inserted while the patient is under sedation thus avoiding the gagging reflex.
To return to my friend, a hiatus hernia was diagnosed. A hiatus hernia occurs when the upper part of the stomach pushes through the opening in the diaphragm where the oesophagus connects with the stomach, allowing the acid from the stomach to reflux. Fortunately, this was a small hiatus hernia, which could be easily treated with a course of medication.
A couple of years went by with only minor instances of indigestion, then my friend started to experience occasional bouts of very severe heartburn and sickness which she treated with the usual array of antacid preparations. Suddenly, one day she woke up with a severe pain in her lower stomach which didn’t respond to the usual remedies and in any event, didn’t resemble any of the normal symptoms of acid reflux.
A visit to the doctor and my friend found herself hospitalised for tests which revealed that the original small hiatus hernia was larger and bleeding and had lead to gastritis (inflammation of the stomach lining) and duodenitis (inflammation of the duodenum), both caused by an infection with the Helicobacter pylori bacteria. This bacteria is extremely common, thought to infect 70% of the world’s population, although most people do not display any symptoms of the infection.
The moral of this story is “Don’t ignore persistent acid reflux, it may be much more that just indigestion”.
Watch out for my next article on the treatment of acid reflux.